Expert: Thomas Sabalaske DO - 3/16/2008

Question
I had an MRI which found perineural cysts at L4-5 and L5-S1.
Also L1-2 a right paracentral disc herniation (protrusion Type) with narrowing of the right neural foramen. There are few other issues but my question is what should I do about the cysts. I have tried PT, medication, too many shots, exercise 3 times a week at the gym, alternative diets & herbs, and most recently OMT. So many things and still I have so much pain that I can barely function some days. I have a horrible limp, pain on my right side that does not stop, numbness in my right legs, trouble bending, walking...climbing stairs can send shock waves through my body that make me want to throw up.
I'm young and was completely healthy until I hurt myself 3 years ago. I can not seem to find a solution or anyone who can help me heal. The pain is unbearable. And now after 4 OMT treatments I am struggling with vaginal bleeding for more than 3 weeks. Please advise me what my next step to recovery should be?

Answer
  Hi Karen, sorry to hear you aren't feeling well.  Of course, without examining you and having all of your records, I can't give any specific  medical advice, just a few thoughts.  First, about the perineural arachnoid cysts, the first question that should be answered is are they positive these are merely benign arachnoid cysts or could they be another type.  I usually have a good spine surgeon have a look-see and say yes or no.  Second, it really depends on the leg pain pattern that would tell us which nerve is being impinged and hence, where to look to fix the problem, different nerves hurt different parts of the legs, so a good physician will be able to tell you the pattern OR maybe the pain in the legs is not nerve related at all, but musculoskeletal from the rest of the back issues, simple nerve tests can differentiate all of these.  Third, if for the last 3 years you have been in constant pain with the numbness/weakness in the legs, and shock wave pains throughout your body, this sounds to be more than your typical low back pain story, I'm all for conservative therapy, but probably a visit with a GOOD spine doctor to look at you, hear your story and look at the MRI's etc to make sure there isn't anything urgent they would need to repair...chronic weakness in a nerve root distribution that doesn't get better raises a red flag for me.  Lastly, assuming there is no urgent surgical needs, osteopathic manipulation is a wonderful help for many conditions, however it would probably take more than 4 treatments to calm down 3 years of a pain/dysfunction syndrome.  Osteopaths vary in their style and abilities, so that is another variable factor in the mix.  About the vaginal bleeding, assuming they kept their treatment external to the vagina, it is not uncommon to sometimes have variations in the menstrual cycle after osteopathic treatment due to changing around lymphatic drainage and parasympathetic nerves that affect such matters, but again not being your physician I would advise you to investigate that with your personal gynecologist.  Thank you for writing and let me know if there is any other general knowledge I can help you with.   Dr. S.